Adverse mental health outcomes in a population-based cohort of survivors of childhood cancer

Background — The elevated risk for physical late effects in childhood cancer survivors (CCS) is well documented, but their risk for mental health problems is less well described.

Methods — We assembled a cohort of all five-year CCS diagnosed before age 18 years and treated in an Ontario pediatric cancer center between 1987-2008. Patients were matched to population controls, and linked to health administration databases. We calculated rates of mental healthcare visits (family physician, psychiatrist, emergency department [ED], hospitalization) and risk for a severe mental health event (ED, hospitalization, suicide). Outcomes were compared using recurrent event and survival analyses.

Conclusion — CCS experience higher rates of mental health visits and a greater risk for a severe event than the general population. Survivors of adolescent cancer have a higher rate of mental health visits overall, while survivors of cancer prior to age 4 have a markedly elevated risk of severe events.